A Primer for Primary Care

Source: Diagnostic musculoskeletal US for physiatrists: new perspectives from different vantage points. Dr. Jay Smith (Mayo Clinic). American Academy of Physical Medicine and Rehabilitation 69th Annual Assembly; San Diego, CA: November 20-23, 2008. When performing diagnostic musculoskeletal ultrasound examinations, the practitioner must adhere to the following vital steps to maximize the best outcomes: • Define a specific clinically relevant question that may be answered by the ultrasound examination • Position the physician, patient, and machine for the best access • Maintain full control of the transducer probe using the “hands-on” approach • Completely evaluate the region of concern to avoid any unnecessary errors by viewing multiple images to reconstruct a 3-dimensional view • Evaluate the targeted structures in both longitudinal (long axis) and transverse (short axis) planes to increase diagnostic sensitivity and reduce artifactual anisotropy When using ultrasound guidance for interventional procedures, several principles should be maintained: • Determine the specific procedure or goal for diagnostic or therapeutic value • Review the entire regional anatomy adequately using methods including Doppler ultrasound • Use sterile techniques as recommended • Choose the long axis (“in-plane”) approach, so that the needle tip and shaft are linearly aligned with the long axis of the transducer and, thus, provide ultrasonographic visualization of the needle at its target • Maintain the needle tip position throughout the procedure • Recognize the inherent limitation of the physician, technique, and equipment while using the “free-hand technique”